NPI | 1740480839 |
---|---|
Entity Type | Organization |
Authorized Contact | PHILIP D JENSEN Provider 208-343-1702 |
Organization Subpart ? | No |
Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ID M-8875) |
Enumeration Date | 2007-07-18 |
Last Update Date | 2019-07-19 |